Tuesday, November 22, 2022

How Effective Is Chemotherapy For Prostate Cancer

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How Can I Help Myself During Chemotherapy

There are many easy things you can do to help yourself during chemotherapy. What you do can help you:

  • Feel better
  • Work out any problems that may come up
  • Work with your doctor and health care team to help you get better
  • Step 1: Tell your doctor if you have any side effects from your treatment. Each person who gets chemotherapy will have one or more side effects from the treatment. What side effect each person goes through is different. The good news is that there are ways to deal with most of the side effects from your chemotherapy treatment.
  • Step 2: Ask your doctor before you take any other medicine. Some medicines can interfere or react with your chemotherapy medicines. Tell your doctor about any medicines that you are taking. This includes over-thecounter medicine like vitamins or aspirin that you may take along with your chemotherapy medicine. Talk to your doctor or health care team before you start taking any new medicines.
  • Step 3: Take care of your health. Try to eat a healthy diet while you have your chemotherapy. Stay away from people who have colds or the flu. Your body can be weakened by the chemotherapy medicine. Their germs could make you sick. Have all the blood tests your doctor tells you to. These tests let your doctor and healthcare team know how you are doing and how your body is handling your chemotherapy medicines.
  • Where You Have Chemotherapy

    You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so its a good idea to take things in to do. For example, newspapers, books or electronic devices can all help to pass the time. You can usually bring a friend or family member with you.

    You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that you take home.

    For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.

    Clare Disney : Hello, my name is Clare and this is a cancer day unit.

    So when you arrive and youve reported into with the receptionist, one of the nurses will call you through when your treatment is ready, sit you down and go through all the treatment with you.

    Morning, Iris. My name is Clare. I am the nurse who is going to be looking after you today. Were going to start by putting a cannula in the back of your hand and giving you some anti sickness medication. And then I am going to come back to you and talk through the chemotherapy with you and the possible side effects you may experience throughout your treatment. Is that okay?

    Each chemotherapy is made up for each individual patient, depending on the type of cancer they have and where it is and depending their height, weight and blood results.

    Side Effects Of Hormone Therapy

    • Hot flushes. In most men treated with hormonal therapy for metastatic prostate cancer, hot flushes are fairly limited. If you are especially troubled by hot flushes, ask your doctor about medications that can help, such as low doses of female hormones or antidepressants such as venlafaxine or sertraline .
    • Osteoporosis . Lowered testosterone levels lead to a loss of calcium, which may cause osteoporosis . Treatment with bisphosphonates, such as zoledronic acid or denosumab can help reverse the effects of osteoporosis, reducing pain and lowering the risk of fractures.
    • Weight gain. When mens testosterone levels go down, their metabolism can change, causing them to retain fluid and gain weight. Hormone treatments can result in a loss of muscle mass. Stay active by walking, doing chores, and engaging in physical activities you enjoy. Weight training can also help build and maintain muscle strength and structure. Be sure to consult with your health care team before beginning any exercise program.

    Will Chemotherapy Cure My Prostate Cancer

    No, chemotherapy will not cure your prostate cancer, because it does not kill all of your prostate cancer cells. But chemotherapy helps control your prostate cancer. It may:

  • Slow the growth of your prostate cancer by killing cancer cells that may have moved to other parts of your body.
  • Shrink your prostate cancer.
  • What Are The Side Effects Of Hormone Therapy For Prostate Cancer

    Prostate Cancer Treatment Options

    Because androgens affect many other organs besides the prostate,  can have a wide range of side effects , including:

    • loss of interest in sex
  • Studer UE, Whelan P, Albrecht W, et al. Immediate or deferred androgen deprivation for patients with prostate cancer not suitable for local treatment with curative intent: European Organisation for Research and Treatment of Cancer Trial 30891. Journal of Clinical Oncology 2006; 24:18681876.

  • Zelefsky MJ, Eastham JA, Sartor AO. Castration-Resistant Prostate Cancer. In: Vincent T. DeVita J, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles & Practice of Oncology, 9e. Philadelphia, PA: Lippincott Williams & Wilkins; 2011.

  • Smith MR, Saad F, Chowdhury S, et al. Apalutamide and overall survival in prostate cancer. European Urology 2021; 79:150158.

  • Endocrine Therapy And Prostate Cancer

    Male hormones, specifically testosterone, fuel the growth of prostate . By reducing the amount and activity of testosterone, the growth of advanced prostate is slowed. Hormone therapy, known as androgen ablation or androgen suppression therapy, is the main treatment for advanced prostate cancer. It is the first line of treatment for metastatic prostate cancer.

    In many patients, endocrine therapy provides temporary relief of symptoms of advanced prostate cancer. Endocrine therapy may reduce tumor size and levels of prostate specific antigen in most men. PSA is a substance produced by the prostate gland that, when present in excess amounts, signals the presence of prostate cancer.

    However, hormone therapy is not without side effects. Some of the more serious side effects include loss of sex drive, impotence, weakened bones , and problems.

    Eventually, most patients with advanced prostate cancer stop responding to hormone therapy. Doctors call this castrate-resistant prostate cancer.

    Chemotherapy And Other Treatments

    Doctors sometimes recommend chemotherapy as a treatment for hormone-resistant prostate cancer, usually for men who fall into one of three groups:

    • Those with fast-rising PSA levels. When the PSA level begins doubling or tripling so quickly that hormone treatments cant control it, chemotherapy may be an option.
    • Those who are developing symptoms. Chemotherapy should be considered if a man with metastatic prostate cancer is losing weight, looking pale, or experiencing physical distress.
    • Those who have metastatic cancer that is growing quickly. These men are sometimes treated with radiation aimed at multiple tumor sites. However, radiation treatments to the bone can reduce the number of red blood cells in the bone marrow and lead to anemia. Using chemotherapy may reduce the need for radiation.

    In the treatment of metastatic prostate cancer, one chemotherapy drug is usually given, rather than multiple drugs being given in combination. Some of the drugs used are docetaxel , cabazitaxel , mitoxantrone and estramustine .

    In most cases, the first chemotherapy drug given is docetaxel, combined with the steroid drug prednisone. If this drug does not work , other chemotherapy options may be tried. Doctors give chemotherapy in cycles; each cycle typically lasts a few weeks. A period of treatment is followed by a period of rest, which allows the body time to recover.

    Chemotherapy is very unlikely to cure prostate cancer, but it may slow the cancers growth and reduce symptoms.

    Possible Side Effects Of Chemotherapy

    Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow , the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells can also be affected by chemo, which can lead to side effects.

    The side effects of chemo depend on the type and dose of drugs given and how long they are taken. Some common side effects can include:

    These side effects usually go away once treatment is finished. There are often ways to lessen these side effects. For example, drugs can be given to help prevent or reduce nausea and vomiting.

    Along with the risks above, some side effects are seen more often with certain chemo drugs. For example:

    • Docetaxel and cabazitaxel sometimes cause severe allergic reactions. Medicines are given before each treatment to help prevent this. These drugs can also damage nerves , which can cause numbness, tingling, or burning sensations in the hands or feet.
    • Mitoxantrone can, very rarely, cause several years later.
    • Estramustine carries an increased risk of blood clots.

    If you notice any side effects while getting chemo report them to your cancer care team so that they can be treated promptly. In some cases, the doses of the chemo drugs may need to be reduced or treatment may need to be delayed or stopped to prevent the effects from getting worse.

    To learn more, see .

    Surgery For Prostate Cancer

    In some cases of advanced or recurrent prostate cancer, surgeons may remove the entire prostate gland in a surgery known as “salvage” prostatectomy. They usually do not perform the nerve-sparing form of prostatectomy. Often, surgeons will remove the pelvic lymph nodes at the same time.

    Cyrosurgery may be used in cases of recurrent prostate cancer if the cancer has not spread beyond the prostate. Cryosurgery is the use of extreme cold to destroy cancer cells.

    To reduce testosterone levels in the body, doctors may sometimes recommend removing the testicles, a surgery called orchiectomy. After this surgery, some men choose to get prosthetics that resemble the shape of testicles.

    Doctors may also remove part of the prostate gland with one of two procedures, either a transurethral resection of the prostate or a transurethral incision of the prostate . This relieves blockage caused by the prostate tumor, so urine can flow normally. This is a palliative measure, which means it is done to increase the patient’s comfort level, not to treat the prostate cancer itself.

    Side Effects Of Chemotherapy For Prostate Cancer

    Chemicals in chemotherapy drugs kill cells that divide quickly, but they cant differentiate between cancer cells and healthy cells in your body.

    Many of chemotherapys side effects are due to drugs targeting healthy cells that divide rapidly such as cells in your:

    • bone marrow

    10 percent of participants have grade 3 or 4 neuropathies, which are the highest classifications of nerve dysfunction. Your chances of developing neuropathy depend on your dose.

    According to the American Cancer Society, the drug mitoxantrone can cause leukemia in rare cases, and estramustine increases your risk of developing blood clots.

    What Can Be Done To Treat Or Reduce Side Effects

    Once chemotherapy treatment is complete, its side effects will typically cease. However, steps can be taken to combat any side effects as they occur. For instance, medications can help prevent nausea and vomiting, laxatives or stool-binding medications can manage constipation or diarrhea, respectively, and numbing gel can soothe mouth sores. Additionally, chemotherapy dosages can be changed or alternative chemo drugs can be considered, if appropriate.

    Docetaxel: Role In Mcrpc

    Up until 2004, there was still no standard front-line or second-line chemotherapy for mCRPC that improved OS. Treatment options for mCRPC at the time often included second-line hormonal therapy, radiation therapy, cytotoxic chemotherapy, investigational therapy, or supportive care. Chemotherapy was clearly shown to provide palliative benefit but no survival benefit, and the regimens available at the time, as aforementioned, were mitoxantrone, estramustine, or docetaxel.

    Docetaxel is a taxane derivative that works by binding to microtubules and preventing androgen receptor nuclear translocation and causing apoptosis through B-cell lymphoma phosphorylation. Studies using docetaxel as a single agent or in combination with estramustine showed objective response rates in up to 38% of patients, PSA declines of more than 50% in 69% of patients., These findings encouraged subsequent two trials: the TAX 327 trial and the Southwest Oncology Group 99-16 trial.

    These two studies, primarily the TAX 327 and secondarily the SWOG 9916, have set the standard of care for men with mCRPC. Numerous subsequent combination trials have been performed in an attempt to improve upon the efficacy of docetaxel, but most of these have been largely negative trials.

    How Is Chemotherapy Given

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    Chemo drugs for prostate cancer are typically given into a vein , either as an infusion over a certain period of time. This can be done in a doctors office, chemotherapy clinic, or in a hospital setting. Some drugs, such as estramustine, are given as a pill.

    Often, a slightly larger and sturdier IV is required in the vein system to administer chemo. They are known as central venous catheters , central venous access devices , or central lines. They are used to put medicines, blood products, nutrients, or fluids right into your blood. They can also be used to take out blood for testing.

    Many different kinds of CVCs are available. The most common types are the port and the PICC line.

    Doctors give chemo in cycles, with each period of treatment followed by a rest period to give you time to recover from the effects of the drugs. Cycles are most often 2 or 3 weeks long. The schedule varies depending on the drugs used. For example, with some drugs, the chemo is given only on the first day of the cycle. With others, it is given for a few days in a row, or once a week. Then, at the end of the cycle, the chemo schedule repeats to start the next cycle.

    The length of treatment for advanced prostate cancer is based on how well it is working and what side effects you have.

    Cancercares Free Support Services And Programs

    Receiving a diagnosis of metastatic prostate cancer can be very difficult, and adjusting to the necessary changes in your life can be challenging.

    CancerCare can help. We are a national nonprofit organization providing free, professional services to anyone affected by cancer. Our licensed oncology social workers can provide support and education, help in navigating the complicated health care system, and provide information on support groups and other resources.

    To learn more about how CancerCare helps, call us at 800-813-HOPE or visit .

    You will likely also build your own personal support network, comprised of family and friends. In doing so, its best to take some time to think about the people in your life and how they are best suited to help. Match the task to their strengthsask a family member who loves to shop to pick up something for you at the store; ask a friend whos a good listener to come over for a chat.

    Chemotherapy Drugs Used For Prostate Cancer

    Chemotherapy drugs used to treat prostate cancer are:

    • docetaxel

    The following drug combinations are used to treat prostate cancer:

    • docetaxel and prednisone
    • estramustine and etoposide
    • estramustine and vinblastine
    • estramustine and paclitaxel

    The following drug combinations are used to treat prostate cancer if an changes into a more aggressive type of cancer called a small cell carcinoma of the prostate:

    • cisplatin and etoposide
    • carboplatin and etoposide

    Dealing With Prostate Cancer

    Some men say being diagnosed with prostate cancer changes the way they think and feel about life. If you are dealing with prostate cancer you might feel scared, worried, stressed, helpless or even angry.

    At times, lots of men with prostate cancer get these kinds of thoughts and feelings. But theres no right way that youre supposed to feel and everyone reacts in their own way.

    There are things you can do to help yourself and people who can help. Families can also find this a difficult time and they may need support too. Find out more.

    Standards Of Care In Hormone Therapy

    Most doctors agree that hormone therapy is the most effective treatment available for patients with advanced prostate cancer. However, there is disagreement on exactly how and when hormone therapy should be used. Here are a few issues regarding standards of care:

    Timing of Cancer Treatment

    The disagreement is due to conflicting beliefs. One is that hormone therapy should begin only after symptoms from the metastases, like bone pain, occur. The counter belief is that hormone therapy should start before symptoms occur. Earlier treatment of prostate cancer is associated with a lower incidence of spinal cord compression, obstructive urinary problems, and skeletal fractures. However, survival is not different whether treatment is started early, or deferred.

    The only exception to the above, is in lymph node-positive, post-prostatectomy patients, given androgen deprivation as an adjuvant immediately after surgery. In this situation, immediate therapy resulted in a significant improvement in progression free survival, prostate cancer specific survival, and overall survival.

    Length of Cancer Treatment

    The disagreement in this situation is between continuous androgen deprivation and intermittent androgen deprivation.

    Combination vs. Single-Drug Therapy

    What Is Intermittent Adt

    Researchers have investigated whether a technique called intermittent androgen deprivation can delay the development of hormone resistance. With intermittent androgen deprivation, hormone therapy is given in cycles with breaks between drug administrations, rather than continuously. An additional potential benefit of this approach is that the temporary break from the side effects of hormone therapy may improve a mans quality of life.

    Randomized clinical trials have shown similar overall survival with continuous ADT or intermittent ADT among men with or prostate cancer, with a reduction in some side effects for intermittent ADT .

    First Evidence That Chemotherapy Extends Life In Advanced Prostate Cancer

    Key wordsProstate cancer, , .

    SummaryChemotherapy regimens that include the drug docetaxel extend median survival by two to three months in patients with advanced prostate cancer that is no longer responsive to hormone therapy, two large phase III studies have shown. These are the first clinical trials to show that chemotherapy can improve survival in advanced prostate cancer.

    BackgroundTherapies that lower the body’s level of the male sex hormone testosterone, which encourages prostate cancer growth, are the mainstay of treatment for prostate cancer that has spread to other organs. However, many patients stop responding to hormonal therapies after two to three years of treatment. No effective therapy currently exists for advanced prostate cancer that stops responding to hormonal therapy.

    Chemotherapy with the drugs and has been shown to reduce pain in men with advanced prostate cancer that has spread to the bones, but this regimen does not help patients to live any longer. Several previous studies of different chemotherapy regimens had failed to identify a drug or combination of drugs that extended patients’ survival.

    Study 1 This study involved 770 men with advanced prostate cancer no longer responding to hormonal therapy. The men were randomly assigned to treatment with the drugs docetaxel and estramustine or with prednisone and mitoxantrone. The latter treatment is the only currently approved treatment for prostate cancer patients at this point in their disease.

    Physical Emotional And Social Effects Of Cancer

    Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

    Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

    Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options.

    During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

    Getting Chemotherapy Through An Iv

    Chemotherapy more effective than second targeted hormone ...

    If you are getting chemotherapy medicines that are given through an I.V. , you will go to a clinic on the day you are scheduled to have your chemotherapy. If your blood test shows that you can get your chemotherapy, a chemotherapy nurse will start you on an I.V. A thin needle is carefully placed into one of the veins in your arm or in the back of your hand. The needle will be taken out of your arm when your chemotherapy treatment is finished. This needle will be connected to two bags of liquid by a small tube. One bag contains your chemotherapy medicine. The second bag contains a fluid that will be used: 1) to wash all the chemotherapy medicine out of the tubing and into your body and 2) to make sure that you have fluid going into your vein until the nurse removes the needle. This extra fluid will help you feel better during your treatment. The chemotherapy nurse will give the medicine to you slowly through the I.V. Everything will probably go well during your treatment. If you have a problem during your treatment, there will be a nurse nearby who will check on you while you get your chemotherapy. Do not be afraid to tell the nurse if you do not feel good or if your arm starts to hurt at the place where the needle goes into your vein.

    Surgically Removing The Prostate Gland

    A radical prostatectomy is the surgical removal of your prostate gland. This treatment is an option for curing prostate cancer that has not spread beyond the prostate or has not spread very far.

    Like any operation, this surgery carries some risks.

    A recent trial showed possible long-term side effects of radical prostatectomy may include an inability to get an erection and urinary incontinence.

    Before having any treatment, 67% of men said they could get erections firm enough for intercourse.

    When the men who had a radical prostatectomy were asked again after 6 months, this had decreased to 12%. When asked again after 6 years, it had slightly improved to 17%.

    For urinary incontinence, 1% of men said they used absorbent pads before having any treatment.

    When the men who had a radical prostatectomy were asked again after 6 months, this had increased to 46%. After 6 years, this had improved to 17%.

    Out of the men who were actively monitored instead, 4% were using absorbent pads at 6 months and 8% after 6 years.

    In extremely rare cases, problems arising after surgery can be fatal.

    It’s possible that prostate cancer can come back again after treatment. Your doctor should be able to explain the risk of your cancer coming back after treatment, based on things like your PSA level and the stage of your cancer.

    After a radical prostatectomy, you’ll no longer ejaculate during sex. This means you will not be able to have a child through sexual intercourse.

    Types Of Chemotherapy Drugs

    The most common chemotherapy drug for prostate cancer is docetaxel , which is usually given with prednisone, a steroid medicine. After starting docetaxel, many men experience the improvements in disease-related symptoms, including pain, fatigue and loss of energy.

    If docetaxel does not work or stops working, cabazitaxel may be used.

    Treatment Options For Advanced Prostate Cancer

    Its rare for prostate cancer to metastasize, or spread to other parts of the body. In about 90 percent of all cases, this  of cancer is diagnosed in its early stages, when the disease is confined to the prostate. However, when the disease metastasizes, prostate cancer cells tend to spread to the brain, bones, lungs and liver. Metastatic prostate cancer cells may also be found in lymph nodes outside the pelvis.

    In some cases, the treatment options for advanced prostate cancer may be considered palliative, used to relieve symptoms and improve quality of life. Treatment options include:

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